Vaginal Repair of Symptomatic Postcesarean Isthmocele: Evaluating A Simple Novel Technique

METHODS:

• Subjects: women in childbearing period with abnormal uterine bleeding or infertility attributed to post cesarean isthmocele (sample size to be calculated)
• Preoperative evaluation: transvaginal ultrasound to exclude any other uterine or adnexal pathology, and to measure:

1. Distance from the external cervical os to the lower end of the isthmocele (A)
2. Distance from the external cervical os to the upper end of the isthmocele(B)
3. Length of the isthmocele (B-A)
4. Residual myometrial thickness (the least) of the isthmocele.

• Routine preoperative workup.

• The technique:

• Postmenstrual

• Spinal anesthesia

• Sterilization of the perineum and vagina

• Cervical dilation up to 8mm using Hegar's dilators

• Marking the previously measured points A & B

• Making 2 transverse incisions, one 5mm below A and the other 5 mm above B.

• The rectangular area between the 2 incisions is excised while the Hegar's dilator number 8 in in situ.

• Hemostasis is performed using diathermy.

• The upper and lower edges of the incision are approximated using number 2/0 vicryl on cutting needle taking 3 to 4 interrupted sutures

• The patients with uneventful postoperative course are discharged from hospital after 8 hours with doxycycline 100 mg bid for 5 days.

• Sexual intercourse is avoided for 4 weeks postoperative

• postoperative transvaginal ultrasound follow up; at 1 month postoperative.

• Data will be statistically analyzed and results will be tabulated.